The Culture and Challenges of Health Care IT Leadership

By Rachael Britt-McGraw, Chief Information Officer, Tennessee Orthopaedic Alliance

Rachael Britt-McGraw, CIO, Tennessee Orthopaedic Alliance
Rachael Britt-McGraw, CIO, Tennessee Orthopaedic Alliance
I’ve been fortunate to work in the field of Information Technology for over 25 years now, serving within virtually every discipline of IT in some of the world’s largest companies and across many different industries. When I came into the health care industry back in 2012, I was shocked by the IT landscape and wondered at how it could be so far behind other industries from a technology perspective. None of the industries I’ve served in the past faces the challenges that health care faces today. The industry has largely gone surprisingly unregulated, and within only the past few years there has been a glut of regulatory requirements introduced. There are suddenly huge technological demands upon the industry that cannot now be quickly or easily met. Today, there is a lack of strong IT underpinning across the board and the IT talent pools with heath care experience are shallow, while need for that talent is at an all-time high.
In general terms, for many years, there was significant underfunding of technology infrastructure and an underestimation of the need for and value of strong IT professionals within the health care industry. Adoption of core maintenance systems, standardization, and technological best practices has lagged as compared with other industries. Change control, proper software testing and quality assurance measures, and other widely accepted ITIL concepts are only now finally gaining traction within health care. Much to my amazement, a large percentage of executives at health care and hospital entities have not historically viewed Information Technology as a strategic part of their business. Rather, many have viewed IT as a necessary and expensive evil that cannot possibly be understood. In these environments there is often no IT influence on the Board of Directors or IT seat at the table for strategic planning, grave and costly mistakes in today’s business world.
To make any company’s Information Technology investments valuable, it is necessary first and foremost to recognize the need to seat IT leadership at an executive and strategic level. It is of course necessary that these people understand technology and the application of it to meet business goals, but it is also necessary for the CIO to understand all areas of the organization. The CIO is in a unique position to see data flows, inputs, outputs and requirements of all disparate areas and departments within a business, and is the only person who must gain this level of detailed understanding in order to be successful. That is to say, the savvy CFO with deep financial acumen can apply that, for example, and do a fine job with the financials, reporting, payroll, AR/AP and debt structure without really understanding the work flow of patients through every step of a clinic or hospital, or the specific duties of front desk, clinical, or imaging staff positions. But the savvy CIO with deep technical skills cannot apply just those technical skills and expect success utilizing technology to drive efficiency in those positions. If the CIO does not understand these details, software will be purchased or developed that doesn’t meet the business needs, or worse yet , cripples the ability to drive efficient business flow.
The successful health care CIO must understand technology, and the detailed business operations and business strategy. But they also must understand, support and make recommendations for solutions to meet the financial needs of the business, reporting requirements, legal, regulatory and compliance requirements, and how data will be interfaced and consumed between the various part of the organization. This ultimately leads the CIO to necessarily be an influencer and relationship builder, wearing among all the others, a change agent hat quite often.
Today’s health care IT leadership inherits a myriad of problems and issues. In its effort to impose much needed regulation of the industry, the US government rolled out the Meaningful Use program. This program sought to get health care providers and entities utilizing basic technology and to move the industry away from paper records to electronic records. This government program “certified” particular software programs and required all health care providers to buy and use one of these “certified” systems to gather and report health related data. Unfortunately, they did not include knowledgeable, technically savvy executive level IT strategists in forming the requirements and the resulting work product, predictably, lacked a forward-thinking data strategy. Thus we lost a one-time opportunity to support significant reduction of waste in the industry, and to later allow interoperability of health data.
No single identifier, for example, was selected to be a unique patient identifier. Today the argument continues as to using a person’s social security number, which is widely opposed, so to see the whole picture of a given patient, the industry must try to match up records from various medical practices and hospitals based on several data elements for a given patient. The process is severely flawed, the data fluid and subject to human error, so a large percentage of the health data records lack integrity. Lack of a consistent unique patient identifier means no ability exists to create a single personal health record that could follow a patient throughout their lifetime and aggregate all of the illnesses and /or treatments that person may have. Because of lack of this visibility and a single record, tests are repeated and waste is rampant. Such a record would drive waste out and improve care and health immensely, so this was a significant oversight. Further, data definitions specifying length and type of each data element were not defined and required as a part of “certification”, which would have later made the systems readily able to exchange data. Today, one certified Electronic Health Record system may have a patient identifier field that comprises 10 alpha-numeric characters, whereas the next certified system might have an 8 character numeric only patient identifier, exacerbating an already complex and flawed data landscape within health data and making data exchange unnecessarily complicated.
When I came into the health care field 6 years ago, I was not aware of any of these challenges, government programs, or technological challenges. At some point, every person will likely be a patient, so I believe it is very important for everyone to understand these truths within our health care delivery system in the US.